Figure 1.

Multiparametric CMR demonstrating Lake Louise Criteria for acute myocarditis. (A) T₂ STIR imaging demonstrating high global myocardial signal intensity relative to remote skeletal muscle with a signal intensity ratio >2.0; (B) T₁ mapping using ShMOLLI demonstrating significantly prolonged T₁ times of >1,000 ms (local normal range 941±23 ms at 1.5T) in primarily the lateral and anterior walls; (C) T₂ mapping demonstrating significantly prolonged T₂ times of >55 ms (local normal range 44–52 ms at 1.5T) in the lateral and anterior walls. Quantification of T₁ and T₂ times is performed using specialist software rather than visual assessment; (D,E) late gadolinium enhancement imaging demonstrates patchy subepicardial and mid-wall enhancement in the anterior, lateral and inferior walls, consistent with myocarditis. CMR, cardiovascular magnetic resonance; STIR, short tau inversion recovery; ShMOLLI, shortened modified look-locker inversion recovery.